经颅刺激运动诱发电位联合体感诱发电位监测在脊柱畸形手术中的应用

 目的分析联合应用经颅刺激运动诱发电位(transcranial electric stimulation motor evoked potential, TcMEP)+体感诱发电位(somatosensory-evoked potential, SEP)的多模式术中神经功能监测对预 测脊柱畸形矫形手术中医原性神经功能损害的意义。方法 在脊柱畸形矫形手术中, 同时应用 TcMEP 和(或)SEP进行神经功能监测。 MEP监测采用经颅刺激 ₃、C₄, 记录外周肌源性 MEP, SEP监测采用刺 激双侧胫后神经, 记录置于 C_z-FP_z。阳性诊断标准为, 与基线相比, MEP波幅下降 75%, SEP波幅下降 50%。结果 153例脊柱畸形患者中, 150例成功进行了术中 MEP监测, 83例进行了术中 SEP监测。联 合 MEP、SEP监测的检出率为 100%。MEP监测阳性共 12例, 所有患者中有 1例出现永久性神经功能障 碍, 4例出现一过性神经功能障碍。 MEP监测的敏感性为 90.9%, 特异性为 98.6%; SEP监测敏感性为 54.5%, 特异性为 94.3%;联合 MEP、SEP监测的敏感性达 92.3%, 特异性为 99.3%。结论 联合 MEP+ SEP的多模式术中神经功能监测可提高监测的敏感性及特异性, 可预测术中神经功能损伤事件的发生。 MEP是多模式监测的基础, 而 SEP是重要补充。

Combined monitoring of transcranial electric stimulation motor evoked and somatosensory-evoked potentials during surgery for spine deformity

Objective To analyze the predictive value of combined intraoperative transcranial electric stimulation motor evoked potential (MEP) and somatosensory-evoked potential (SEP) for iatrogenic neurological impairment during surgical correction of spine deformity. Methods MEP and/or SEP monitoring was performed simultaneously with the correction surgery for spine deformity. C₃ and C₄ (International 10 -20 system) were used for stimulation to elicit MEP and compound muscle action potentials (CMAPs) were recorded from the distal limbs. The tibial nerves were stimulated to record SEP. Alterations with MEP wave amplitude decreasing more than 75% and SEP amplitude decreasing more than 50% were diagnosed as positive changes. Results MEP monitoring was successfully performed in 150 of 153 cases and 83 cases of them also accepted SEP monitoring simultaneously. MEP positive alterations were presented in 12 cases. One patient had irreversible neurological deficit and 4 patients had transient neurological deficit. All the five cases were detected by MEP monitoring alone. SEP lagged MEP for average 15 min when both presented with positive changes. The sensitivity and specificity of MEP were 90.9% and 98.6% respectively. Solo SEP was 54.5% and 94.3% respectively. Combined MEP and SEP were 92.3% and 99.3% respectively. Conclusion Combined SEP/MEP monitoring provides higher sensitivity for intraoperative monitoring during spine deformity correction and can predict events of neurological injury. Detection of monitoring changes and adjustment of surgical strategy may prevent irreversible neurological deficit.